Prevention of venous thromboembolism after ischemic stroke.
ABSTRACT Venous thromboembolism is an important cause of morbidity and mortality after stroke. Its potential for prevention is substantial with the use of antithrombotic agents, but there is no agreement on the relative advantages and disadvantages of various available prophylactic drugs. There have been recent publications that clarify some of these issues.
Data from recently published controlled clinical trials have added to our understanding of the risk-benefit ratio of the two most commonly used antithrombotics: unfractionated heparin and low-molecular-weight heparins. These data suggest that the low-molecular-weight heparin enoxaparin has a superior clinical profile in comparison with unfractionated heparin.
Antithrombotic agents are the mainstay in the prevention of venous thromboembolism after stroke. The highly effective unfractionated heparin and low-molecular-weight heparins may have a different clinical profile that could have a substantial impact in clinical practice.
Nosotchu 01/2009; 31(1):10-14. DOI:10.3995/jstroke.31.10
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ABSTRACT: The authors present the data of a medical registry which evaluated if the physicians assess VTE risk in stroke patients, during hospitalization period and at hospital discharge and if the thromboprophylaxis is used according to National Guidelines for VTE Prophylaxis. 884 patients with acute ischemic stroke patients were enrolled between June 2010 and December 2011, from 62 centers, 51.4% male and 48.6% female with mean age 70.07 years (68.25 years in the male group and 71.92 years in the female one). There were two co-primary endpoints: the percentage of patients at risk for VTE at hospital admission assessed by the physician, and the percentage of patients with risk factors for VTE that persist at hospital discharge from the total number of patients hospitalized with ischemic stroke. The secondary endpoints were: the percentage of hospitalized patients receiving prophylaxis according to the National Guidelines of VTE Prophylaxis from the total number of patients at risk of VTE, the percentage of hospitalized patients with VTE risk receiving recommendation for thromboprophylaxis at discharge, the duration and the type of VTE prophylaxis in hospitalized patients, the duration and the type of VTE prophylaxis at discharge. 879 (99.4%) of the total number of patients at risk of VTE have received prophylaxis during hospitalization. The most frequently types of prophylaxis used during hospitalisation were LMWH in 96.3% of the patients and mechanic method in 16.6% that were in accordance with the National Guidelines of VTE Prophylaxis recommendations. There is a clear improvement in both assessment and thromprophylaxis recommendation in acute stroke patients with restricted mobility at VTE risk and in our country. LMWH is preferred to unfractionated heparin for venous thromboembolism prophylaxis in this high-risk patient population in view of its better clinical benefits to risk ratio and convenience of once daily administration.
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ABSTRACT: Acute ischemic stroke is the result of abrupt interruption of focal cerebral blood flow. The majority of ischemic strokes are caused by embolic or thrombotic arterial occlusions. Acute stroke management is complex, in part because of the varying etiologies of stroke and the very brief window of time for reperfusion therapy. Efforts to optimize stroke care have also encountered barriers including low public awareness of stroke symptoms. As initiatives move forward to improve stroke care worldwide, health care providers and institutions are being called onto deliver the most current evidence-based care. Updated versions of three major guidelines were published in 2008 by the American College of Chest Physicians, the American Heart Association, and the European Stroke Organization. This article presents a concise overview of current recommendations for the use of fibrinolytic therapy for acute ischemic stroke and antithrombotic therapy for secondary prevention. Future directions are also reviewed, with particular emphasis on improving therapeutic options early after stroke onset.Journal of Thrombosis and Thrombolysis 04/2010; 29(3):368-77. DOI:10.1007/s11239-010-0439-7 · 2.04 Impact Factor